Fieldset
Breech

Alexander is an emergency room doctor from Sweden. He sends us his third blog post from a new assignment in the Central African Republic, a country which has faced many years of violence and instability...

“Urgence pour maternité! Urgence! Urgence pour la maternité!

"Oui, Dr Alexander à l´écoute!

It’s a childbirth complication: the woman is 20 years old, 37 weeks pregnant, and the baby is on its way. But the baby is 'breech', which means it's not coming head first, and the woman has been in labour for a while. Her cervix is fully dilated at 10 cm, but the baby has not emerged. 

I’m here to be an "emergency physician". At home in Sweden, I specialise in general surgery and my obstetric knowledge is limited to the gynaecology module of my medical training (in 2008) and what I learned on my previous assignment with MSF.
 
The local midwives are very competent, but now they need medical help. The mother is tired and the foetal pulse is too high: 190 beats/min and rising.
 
I ask what they usually do at this critical moment? We call a senior medic, they tell me. That is to say, the doctor, i.e. you! I keep calm, as always. In the morning we had two deliveries that had to go to emergency surgery for a cesarean section, one due to uterine rupture and one due to obstructed labour. When they happened I went with Dr. A. (a Central African doctor) who took care of the situation and taught me. But at the moment, the two other doctors at the hospital are busy; they are not reachable on the radio or phone (the signal is generally quite limited). 
 

I want to be completely sure of the next steps

I scout the rooms looking for the surgeon, I want to be completely sure of the next steps. 
 
Episiotomy. What else is needed?
 
Finally, I find the surgeon. He enters the room, calm and determined, and stands on a chair, leaning over the patient. With both hands he pushes on her abdomen, trying to help the extremely tired mother to push out the baby.
 
It takes a few minutes. I assist, standing next to them, the mother screams and the midwife prepares to preform the episiotomy. She begins to cut the skin to widen the opening for the baby.
 

I'm used to coping with stress in all its forms, but right now, of all times, my blood sugar level falls and I start to get dizzy

I am trained in surgery and emergency medicine, I'm used to coping with stress in all its forms, but right now, of all times, my blood sugar level falls and I start to get dizzy. I see a chair next to me, fumble, and sit for 30 seconds after this little girl comes out.
 
I stand up and we head straight to the room next door. The baby is barely moving her arms and legs, she grimaces a bit and can’t breathe on her own. We rub her body to provide some stimulation and suck up mucous from her airways.
 
She's getting paler.
 
I start resuscitation. With a mask, I ventilate the lungs, once. The intern gives three cardiac compressions. Additional ventilation, three cardiac compressions. 
 
And then the child takes a breath on her own, and gives out a healthy cry. Her APGAR score has gone from 6 to 10 and an immense feeling of relief runs through my entire body. She weighs 2.65 kg (just under 6 lbs), is stable at the moment and getting the emergency treatment she needs. As soon as we can, she is taken to the neonatal department.